{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"THGIWDYELLA ","gend":0,"add":"AMWOB 215TEERTS N","city":"SALEM","state":"VA","zip":"24153-6129","dob":"1964-01-12","age":"","mstatus":"","insh":"50014704","cliId":"","pno":"1604505293","cno":"","email":"","ename":"","eno":"","pphy":"CULKIN, BONNIE F","ppno":5403753790,"pcpadd":"431 Apperson Dr, Salem Family Clinic","pcpcity":"Salem","pcpstate":"VA","pcpzip":241537026,"pcpcounty":"","pcpid":"","pcpname":"PHYSICIAN ASSOCIATES OF VIRGINIA","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"ROANOKE\/ ALLEGHANY","aligned":"","ano":"","add2":"","add3":"","madd1":"512 BOWMAN STREET","madd2":"","madd3":"","mcity":"SALEM","mstate":"VA","mzip":"24153-6129","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z11.3","I10","Z95.5","R68.89","Z09","J44.9","E78.2","F32.1","Z55.0","Z12.5","Z12.2","Z23","F12.90","F17.200","Z72.0","R06.2","J44.1","R06.02","R05","I25.10","Z79.51","Z86.73","R06.00","J43.9","Z91.14","J45.909","F17.210","Z59.0","I49.3","J43.1","I25.2","R73.03","Z20.828","R06.89","R06.9","R19.7","J45.901","Z20.822","R35.0","R43.9","R68.83","Z79.02","Z79.01","Z79.84","Z79.1","R07.2","R07.9","R30.0","R07.89","Z87.891","R06.82","K57.30","R10.2","R10.13","R11.0","R11.2","R09.81","Z59.00","J18.9","Z20.9","R09.02","R00.0","M19.90","Z98.61","Z79.899","R91.8","J10.1","J96.01","I50.1","I11.0","Z82.49","Z53.21","I26.99","I51.7","R93.89","R60.9","R10.84","R07.81","J98.4","Z71.6","Z79.82","Z79.52","R10.11","T14.90XA","S22.31XA","R53.1","R42","R10.9","W19.XXXA","Y99.0","I49.1","W19.XXXD","I50.32","J43.2","S22.41XD","I50.9","Z87.81","D72.829","E87.2","R50.9","S22.41XA","Z00.00","Z76.89","Z13.31","Z11.1","Z78.9","E78.00","Z71.89","E78.5","F32.9","Z28.3","I49.8","F41.9","H90.A21","H90.A32","G93.41","E16.2","R41.82","R56.9","G31.9","Z88.0","Z88.8","M50.21","M50.30","M47.812","R40.4","M62.9","R58","S01.81XA","R41.0","W18.39XA","S29.8XXA","S22.060S","M47.814","S39.82XA","M51.36","G93.40","F19.10"],"date":["2020-01-09","2022-01-21","2021-11-11","2020-12-15","2020-01-17","2021-06-09","2020-01-17","2020-01-17","2020-01-17","2020-01-17","2020-01-17","2020-01-17","2021-05-12","2021-11-11","2021-06-09","2022-01-21","2022-01-21","2022-01-21","2020-05-07","2022-01-21","2022-01-21","2021-12-06","2021-06-09","2021-12-06","2020-06-11","2020-06-11","2022-01-21","2021-06-09","2020-12-15","2020-12-15","2022-01-21","2020-12-15","2020-12-15","2022-01-21","2022-01-21","2021-12-06","2021-05-12","2022-01-21","2021-05-12","2021-05-12","2021-05-12","2021-12-06","2021-05-12","2021-05-12","2021-05-12","2021-05-12","2021-05-13","2021-05-13","2021-05-13","2021-05-13","2021-06-09","2021-12-06","2021-12-06","2021-12-06","2021-12-06","2021-12-06","2021-12-06","2021-12-06","2022-01-21","2022-01-21","2019-12-20","2019-08-16","2019-01-27","2019-01-27","2019-02-05","2019-09-06","2019-02-09","2019-02-08","2019-02-08","2019-08-15","2019-02-05","2019-02-05","2019-02-08","2019-02-08","2019-02-08","2019-02-08","2019-10-24","2019-08-16","2019-06-08","2019-06-08","2019-06-08","2019-06-08","2019-08-12","2019-08-12","2019-08-12","2019-12-20","2019-09-06","2019-08-12","2019-12-20","2019-08-12","2019-08-15","2019-08-15","2019-08-15","2019-08-15","2019-08-16","2019-08-15","2019-08-15","2019-08-16","2019-12-20","2019-08-16","2019-08-15","2019-08-28","2019-08-28","2019-08-28","2019-08-28","2019-08-28","2019-08-28","2019-08-28","2019-09-05","2019-11-18","2019-09-05","2019-10-24","2019-11-18","2019-11-19","2019-11-19","2019-12-20","2019-12-20","2019-12-21","2019-12-20","2019-12-20","2019-12-20","2019-12-20","2019-12-20","2019-12-20","2019-12-20","2019-12-20","2019-12-20","2019-12-20","2019-12-20","2019-12-22","2019-12-20","2019-12-20","2019-12-20","2019-12-20","2019-12-20","2019-12-20","2019-12-22","2019-12-21"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}}]},{"t":"Covid Screening","q":[{"a":[]}]},{"t":"Self-Assessment and Social History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":{"indx":[false,false],"comment":["",""],"score":["",""]}},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Activities of Daily Living","q":[{"a":[]}]},{"t":"Medical History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Family History","q":[{"a":[]}]},{"t":"Preventive Care","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","69097014260","ALBUTEROL","69097014260 ALBUTEROL ","6.7","Select","Select",""],["","59267100002","PFIZER","59267100002 PFIZER ","0.3","Select","Select",""],["","00378064205","PREDNISONE","TAB 20MG","10","Select","Select",""],["","53489011905","DOXYCYCL","CAP 100MG","20","Select","Select",""],["","00597002402","COMBIVENT","AER 20-100","4","Select","Select",""],["","65862035790","CLOPIDOGREL","TAB 75MG","30","Select","Select",""],["","70377003012","ATORVASTATIN","TAB 80MG","30","Select","Select",""],["","00069046956","CHANTIX","TAB 1MG","60","Select","Select",""],["","00597007541","SPIRIVA","CAP HANDIHLR","30","Select","Select",""],["","57664050658","METOPROL","TAB 25MG","30","Select","Select",""],["","68180016013","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","59310057922","PROAIR","AER ","8.5","Select","Select",""],["","49281042050","FLUZONE","INJ 2020-21","0.5","Select","Select",""],["","00173086910","ANORO","AER 62.5-25","60","Select","Select",""],["","65862042005","SMZ\/TMP","TAB 800-160","20","Select","Select",""],["","65862039010","ONDANSETRON","65862039010 ONDANSETRON ","20","Select","Select",""],["","57237016199","OMEPRAZOLE","57237016199 OMEPRAZOLE ","14","Select","Select",""],["","10702001801","OXYCODONE","TAB 5MG","15","Select","Select",""],["","00904671980","ACETAMINOPHEN","TA B 325","60","Select","Select",""]]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Review of Systems and Diagnoses","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["1",""],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":[]}]},{"t":"Mini-Cog","q":[{"a":[]},{"a":[]}]},{"t":"Home Safety & Personal Goals","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Active Problem Conditions","q":[{"a":[]}]},{"t":"Patient Summary","q":[{"a1":"","a2":"","a3":"","a4":"","a5":"","a6":"","a7":[],"a8":"","a9":"","a10":[],"a11":"","a12":"","a13":""}]}]}